Healthcare Provider Details

I. General information

NPI: 1770104085
Provider Name (Legal Business Name): DIANA KEKHMAN ARDMS#156912
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2020
Last Update Date: 04/28/2020
Certification Date: 04/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 CONTINENTAL PLZ
HACKENSACK NJ
07601-6328
US

IV. Provider business mailing address

458 E SADDLE RIVER RD
UPPER SADDLE RIVER NJ
07458-1702
US

V. Phone/Fax

Practice location:
  • Phone: 201-661-2254
  • Fax:
Mailing address:
  • Phone: 917-750-4554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number156912
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: